Treating CIN

You may not need any treatment for CIN 1. This is because cells showing CIN 1 often return to normal. You may need to have more frequent screening tests to check for any further changes.

If you have CIN 2 or 3, your doctor may remove the abnormal cells.

There are different types of treatment.

Large loop excision of the transformation zone (LLETZ) is the most commonly used treatment. Usually you will be given local anaesthetic. Once you are comfortable, a colposcopist will remove the abnormal cells with a thin wire loop. The treatment takes about 5–10 minutes.

Some women have a cone biopsy. Usually you are given a general anaesthetic. Sometimes a local anaesthetic is given. Your doctor takes a small, cone-shaped piece of tissue from your cervix, which will be examined under a microscope.

Other treatments for CIN include:

  • laser therapy,
  • cold coagulation,
  • cryotherapy,
  • a hysterectomy or a tracheloctomy. Although these are rarely needed for CIN.

Your doctor will explain which treatment is most suitable for you and what to expect before and after treatment.

Treatments for CIN

Often, cells showing CIN 1 will return to normal without any treatment at all. If your colposcopist decides not to treat these minor changes, they'll arrange for you to have further screening tests. This is to make sure that any further changes that may occur are quickly recognised.

CIN 2 and 3

Most doctors and researchers agree that CIN 2 and 3 should be treated. The aim of treatment is to remove the abnormal area, while causing as little damage as possible to surrounding healthy tissue. It's also possible to destroy the abnormal cells, rather than remove them, although this isn't commonly done.

Ways of removing the abnormal area include:

  • large loop excision of the transformation zone (LLETZ)
  • a cone biopsy
  • a hysterectomy or trachelectomy, although this is rare.

Ways of destroying the cells in the abnormal area so that normal cells can grow back in their place include:

  • laser therapy
  • cold coagulation
  • cryotherapy.

Currently, LLETZ is the most commonly used method of treatment.


How treatments are given

Most women only need one of the treatments described here. All of the treatments are usually very effective at removing the abnormal cells. The type of treatment you have will depend on a number of factors. These will include the facilities available at your local hospital, and the type of treatment that your doctor thinks is best for you.

It may be possible for the treatment to be done at the same time as your initial colposcopy appointment, or you may have to come back at a later date.

LLETZ, laser therapy, cryotherapy, cold coagulation and sometimes cone biopsies are carried out in a hospital outpatient clinic using a local anaesthetic. This means that you can go home after treatment. It can be helpful for someone to either come with you while you're having the treatment or pick you up afterwards.

Before your treatment, the nurse will help you lie comfortably on the couch. The colposcopist will then use a speculum so that they can see your cervix.

Try to relax as much as possible and don't be afraid to ask the colposcopist any questions about your treatment. The treatment itself is likely to take around 5–10 minutes and although it may be uncomfortable, it isn't painful.


The different types of treatment

Large loop excision of the transformation zone (LLETZ)

LLETZ is the most commonly used treatment for removing abnormal cells from the cervix. It's sometimes called LEEP (loop electrosurgical excision procedure). It takes about 5–10 minutes and is usually done under local anaesthetic as an outpatient procedure. Sometimes, if a larger area of the cervix is treated, a general anaesthetic may be used.

Once you're in a comfortable position, the colposcopist will put some local anaesthetic into your cervix to numb it. They'll then use the colposcope to see a magnified image of your cervix and, with a thin wire loop, remove the abnormal tissue. The loop is heated with an electric current, which cuts and seals the tissue at the same time. This shouldn't cause any pain although you may feel some pressure inside your cervix.

The tissue will be sent off to a laboratory to be checked and to confirm the type of abnormal cell changes. Depending on the result, your colposcopist will decide whether you need to be followed up either at the colposcopy clinic or with your GP.

LLETZ is not usually painful, but you may experience a period-like pain or a burning sensation. After the treatment you may have some light bleeding or discharge, which can last for around four weeks. Your doctor or nurse will give you more information about what to expect after your treatment. LLETZ will not affect your ability to enjoy sex once your cervix has healed. But you should avoid sex, swimming, tampons and baths until the cervix has healed and any bleeding has stopped. Your colposcopist will give you more information about this.

Cone Biopsy

This is another treatment for CIN that involves removing abnormal tissue from the cervix.

A cone biopsy is usually carried out under a general anaesthetic, but sometimes a local anaesthetic may be given. The doctor uses a scalpel to take a small, cone-shaped piece of tissue from the cervix, which will be examined under a microscope.

Afterwards, a small pack of gauze (like a tampon) may be put into the vagina to prevent bleeding. This is usually removed within 24 hours before you go home. Some women may also have a tube (catheter) put into the bladder to drain urine while the gauze pack is in place.

It's normal to have some light bleeding and discharge for around four weeks. You should avoid any sex and strenuous exercise for at least four weeks to allow the cervix to heal properly.

Area removed during a cone biopsy
Area removed during a cone biopsy

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Sex after LLETZ or a cone biopsy

Neither LLETZ or a cone biopsy will affect your ability to enjoy sex once your cervix has healed.

Fertility after LLETZ or a cone biopsy

Very rarely, the cervix can become tightly closed after treatment. This is known as stenosis. It can make it harder for the sperm to enter the womb and so can affect your chances of becoming pregnant naturally. Your cervix is not completely closed if you're still bleeding during your periods.

Pregnancy after LLETZ or a cone biopsy

Sometimes treatment can make the cervix slightly weaker. This is unlikely with a single treatment, but if you need more than one treatment the cervix may weaken. Very rarely, this may mean that towards the end of a pregnancy when the baby is bigger, the weakened cervix may start to open early causing a premature birth. To stop this happening, a stitch may occasionally be put into the remaining part of the cervix during pregnancy. The stitch is removed before you go into labour. Your doctor will discuss this with you in more detail if you're concerned about future pregnancies.

Laser therapy or laser ablation

Under local anaesthetic, a laser beam is directed at the abnormal areas of your cervix and the cells are destroyed. During the treatment you may notice a slight burning smell from the laser. This is normal.

Cold coagulation

This is a misleading name as the abnormal cells are removed by heating, not cooling. Firstly, a local anaesthetic is given to numb your cervix, then a hot probe is placed onto its surface.

Cryotherapy

You'll be given a local anaesthetic, and a probe will be put on your cervix to freeze the abnormal cells. Cryotherapy has a slightly lower success rate than the other treatments for CIN, and so it's not often used.

Hysterectomy or tracheloctomy

These types of surgical treatment are rarely needed for CIN.

A hysterectomy

This is an operation to remove the womb and cervix. It's sometimes done for persistent or severe CIN if women have other gynaecological problems and are past childbearing age, or don’t want to have more children. Your doctor may discuss with you whether to remove your ovaries during the surgery. For women who've not yet had the menopause, removing the ovaries will bring on an early menopause.

Find out more about having a hysterectomy.

A trachelectomy

Instead of having a hysterectomy, it's sometimes possible to have an operation where the cervix is removed and the womb is left in place. This type of operation is known as a trachelectomy. Because the womb is left in place, it's still possible to become pregnant after this operation. A trachelectomy is mainly carried out in younger women who still want to have children. Your doctor will be able to give you more information about whether this type of surgery is suitable for you.


Back to Cervical screening

The cervix

The cervix is the lower part of the womb (uterus). It’s often called the neck of the womb.

What is cervical screening?

Cervical screening can help stop cancer developing in the cervix by finding abnormal cells early.

Preparing for having a cervical screening test

A cervical screening test is a very simple procedure and takes less than five minutes.

Getting your cervical screening results

You should get your results within about two weeks of having your cervical screening test.

After treatment for CIN

Most women feel fine after treatment for CIN but some may feel unwell for a few hours. You will be referred for regular screening tests.

Your feelings about cervical screening

People react differently to their screening results. There is no right or wrong way to feel.

Cervical intra-epithelial neoplasia (CIN)

Cervical intra-epithelial neoplasia (CIN) is a term used to describe changes in the surface (squamous) cells of the cervix.

Grading CIN

Knowing the grade of CIN will help your specialist plan the best treatment for you.

Diagnosing CIN

A colposcopy is used to confirm whether you have cervical intra-epithelial neoplasia (CIN) and how severe it might be.